Sedation of patients is currently used for many millions of patients in the United States and the proliferation of invasive medical procedures will result in further increase in the use of this technique. While sedation offers many advantages such as assuring comfort of the patient and pain control, it is also associated with potential complications ranging from a procedure that is started before a patient is adequately sedated to hypoxia, and cardiac arrest. One of the main challenges with sedation within the context of a health care facility is the disjointed character of this practice, which typically includes multipl subspecialists who administer sedation in a variety of settings with different skill sets and the use of various protocols. Training for the provision of sedation is currently also not standardized and each institution has the freedom to create its own training program based on medical staff policies and most hospitals require sedation providers (only) to undergo a written or web-based test on issues such as pharmacology of the drugs to be used. Simulation techniques, on the other hand, are quickly becoming the standard in medical education and proficiency training and it would be ideal to incorporate these techniques into sedation training. However, there is still a paucity of direct evidence that simulation training improves actual patient safety outcomes. The overall aim of the study outlined in this application is to develop an innovative sedation-training program and then test the program using a Sedation Information Management System (SIMS) that will capture continuous vital signs and patient safety and quality outcome data. This application consists of four phases: Phase I: Intervention Development: Through a close collaboration with UCI Medical Education Simulation Center and UCI Sedation Services, develop an intervention (training program) that will include both a high fidelity simulation component and web based cognitive component that will be directed at enhancing the management of moderate sedation for adult patients by non-anesthesiologists. Phase II: Formative Evaluation: Examination of the feasibility and utility of this intervention in a series o focus groups. Phase III: Efficacy RCT Trial: Examine the ability of this intervention to improve both technical and non-technical skills in a population of healthcare providers delivering moderate sedation to adults undergoing invasive procedures. Phase IV: Hospital-Wide Trial: Using a before- after study design Implement the intervention throughout our hospital and collect prospective clinical morbidity and mortality outcome data such as incidence of hypoxia with the use of SIMS over a period of one year with over 5000 patients undergoing sedation. Following demonstration that this intervention will lead to reduced sedation associated morbidity in our hospital; the overall goal is the adoption of this newly developed simulation training program by all health care facilities in the US that provide moderate sedation. This will be done through dissemination of the results of this research as well seeking the endorsement of organizations such as AHRQ, JACHO and CMS.